O大学病院のICUにおける家族看護の課題―看護記録からの分析―

O大学病院のICUにおける家族看護のあり方を検討するため,過去の記録から入室患者の特性と家族の状況を把握し,課題を明らかにした｡128例の看護記録を資料に,患者の入室理由,入室期間,転帰の状況を分類し,入室期間別の家族の言動等から,家族看護の必要性について検討した｡また,家族に対する看護実践を,家族に関する情報の記載の有無から評価した｡その結果,ICU入室患者の9%が死亡退院で,そのうち受け持ち看護師の決まっていない入室後3日以内に死を迎えた患者の家族へのフォローが充分に行えていなかったこと,また,14日以上の長期入室患者の家族には,全事例に家族に関する情報が 記載されており,看護師が家族の気持ちや疲労感,患者への回想などの語りを捉えていたことが明らかとなった｡今後は,短期間で死亡の転帰となった家族へのグリーフケアや,長期入室患者の家族に対する継続看護の評価が必要である。

To study family cares at an intensive care unit (ICU) in O University Hospital, we clarified problems existing in the family cares by grasping patients' character and their family conditions in reference to patients' past records. On the basis of the nursing records of 128 patients, the patients were classified according to reasons for their stay in ICU, their staying period, and how they had left ICU to examine the necessity for family cares mainly from the point how families' sentiment and behaviors differed depending on patients' staying period in ICU. Nursing practice for family cares was evaluated in consideration of whether information about patients' families had been recorded or not. As a result, nine percents of the patients studied had left ICU by death and in case patients died within 3 days in ICU, no nurses in charge of them had been assigned to or no sufficient follow-up cares had been given to their families, while families' information of all the patients staying in ICU for more than 14 days was recorded, which indicated that nurses could share the information with patients' families to understand them. This research showed the importance not only of giving grief cares to the families who had lost their important person after a short stay in ICU, but also of evaluating continuous cares for families with patients in ICU for a long time, suggesting the need for some revision of the present care system to give mental as well as physical cares to both patients and their families regardless of staying period in ICU.